Urban design is key to healthy environments for all
Authors: Thiago Herick de Sa, Abraham Mwaura, Cristina Vert, Pierpaolo Mudu, Nathalie Roebbel, Nhan Tran, Maria Neira
Journal: The Lancet Global Health (2022)

Rapidly increasing urbanisation along with ageing populations, climate change, environmental degradation, COVID-19, and other pandemics present substantial challenges for people living in cities and other communities. The capacity to identify and respond to urban challenges related to health, equity, and sustainability varies greatly across national and subnational governments around the globe, because of the available human and financial resources, structures of governance and participation, and existing policy frameworks, which are all important determinants of healthy and sustainable urban environments. The status of the social and physical urban environments will also determine the magnitude of the challenge and the urgency of the response for each setting.1WHOWHO global strategy on health, environment, and climate change.https://apps.who.int/iris/bitstream/handle/10665/331959/9789240000377-eng.pdf?ua=1Date: 2020Date accessed: April 13, 2022Google Scholar Identifying key challenges and opportunities for interventions is crucial to improving the health and wellbeing gains of urban dwellers and reducing exposure to stressors, shocks, and hazards, while also contributing to fostering wellbeing and reducing health inequalities. Policies and indicators that bring several agendas together can also improve multisectoral action and help maximise gains. For this reason, we very much welcome the Lancet Global Health Series on urban design, transport, and health to support global efforts to develop systems of policy and spatial indicators for healthy and sustainable cities. The title of the Series' introductory Comment by Giles-Corti and colleagues declares: what gets measured gets done.2Giles-Corti B Moudon AV Lowe M et al.Creating healthy and sustainable cities: what gets measured, gets done.Lancet Glob Health. 2022; 10: e782-e785Summary Full Text Full Text PDF PubMed Scopus (6) Google Scholar We agree, and argue that what gets done should also get regularly measured for continuous improvement, making best use of planned interventions, existing policies, and natural experiments to advance knowledge, build expertise, and monitor progress, including on health and wellbeing outcomes. This practice will help us understand how and what to change for the creation of healthy and sustainable urban environments,3WHOCompendium of WHO and other UN guidance on health and environment.https://www.who.int/publications/i/item/WHO-HEP-ECH-EHD-21.02Date: 2021Date accessed: April 13, 2022Google Scholar which is relevant everywhere, but particularly in places and intervention areas where evidence is still scarce (eg, low-income settings).4WHO. Setting global research priorities for urban health. Geneva: World Health Organization (in press).Google Scholar Ensuring and protecting health and wellbeing through improvements in the design of urban environments can only be achieved through the application of an integrated and multisectoral, multistakeholder approach, guided by policy frameworks that ensure that human and environmental health go hand in hand.5UN-HabitatWHOIntegrating health in urban and territorial planning: a sourcebook.https://apps.who.int/iris/handle/10665/331678Date: 2020Date accessed: April 13, 2022Google Scholar Interventions on urban design and transport have the potential to provide large, long-lasting, and immediate benefits for health, and hence are key to healthy and sustainable urban environments for all. If designed with this perspective in mind, urban design and transport policies (along with other interventions) can provide multiple benefits, including: reducing the upward trajectory of greenhouse gas emissions,1WHOWHO global strategy on health, environment, and climate change.https://apps.who.int/iris/bitstream/handle/10665/331959/9789240000377-eng.pdf?ua=1Date: 2020Date accessed: April 13, 2022Google Scholar protecting the environment,1WHOWHO global strategy on health, environment, and climate change.https://apps.who.int/iris/bitstream/handle/10665/331959/9789240000377-eng.pdf?ua=1Date: 2020Date accessed: April 13, 2022Google Scholar fostering equity and intergenerational solidarity,6WHODecade of healthy ageing.https://www.who.int/ageing/decade-of-healthy-ageingDate: 2020Date accessed: April 13, 2022Google Scholar and improving our resilience to future potential pandemics.7WHOWHO manifesto for a healthy recovery from COVID-19: prescriptions and actionables for a healthy and green recovery.https://www.who.int/docs/default-source/climate-change/who-manifesto-for-a-healthy-and-green-post-covid-recovery.pdfDate: 2020Date accessed: April 13, 2022Google Scholar The Series' last paper by Giles-Corti and colleagues8Giles-Corti B Moudon AV Lowe M et al.What next? Expanding our view of city planning and global health, and implementing and monitoring evidence-informed policy.Lancet Glob Health. 2022; 10: e919-e926Summary Full Text Full Text PDF PubMed Scopus (4) Google Scholar highlights the need to enable city planning policy and spatial indicators to track progress and unmask and address spatial inequities in access to health-supportive built environments, support decision making and allocate limited resources, and accelerate the transition towards healthy and sustainable urban environments with multiple benefits for ecosystem, human, and planetary health. We could not agree more. WHO acknowledges the importance of urban design and transport for human and planetary health throughout its programme of work as part of a broader approach to urban health,1WHOWHO global strategy on health, environment, and climate change.https://apps.who.int/iris/bitstream/handle/10665/331959/9789240000377-eng.pdf?ua=1Date: 2020Date accessed: April 13, 2022Google Scholar, 9WHOThirteenth general programme of work 2019–2023.https://www.who.int/about/what-we-do/thirteenth-general-programme-of-work-2019-2023Date: 2019Date accessed: April 13, 2022Google Scholar, 10WHOHealth topic: urban health.https://www.who.int/health-topics/urban-health#tab=tab_1Date accessed: April 13, 2022Google Scholar and strives to provide leadership to effectively protect the health and wellbeing of everyone—in this generation and future generations—through changes to the urban environment.1WHOWHO global strategy on health, environment, and climate change.https://apps.who.int/iris/bitstream/handle/10665/331959/9789240000377-eng.pdf?ua=1Date: 2020Date accessed: April 13, 2022Google Scholar, 5UN-HabitatWHOIntegrating health in urban and territorial planning: a sourcebook.https://apps.who.int/iris/handle/10665/331678Date: 2020Date accessed: April 13, 2022Google Scholar, 9WHOThirteenth general programme of work 2019–2023.https://www.who.int/about/what-we-do/thirteenth-general-programme-of-work-2019-2023Date: 2019Date accessed: April 13, 2022Google Scholar, 10WHOHealth topic: urban health.https://www.who.int/health-topics/urban-health#tab=tab_1Date accessed: April 13, 2022Google Scholar The findings, expansion of the methods, and open-source tools created in this Series provide a highly valuable source of knowledge. We will build on that knowledge and continue to strengthen our work to support countries and cities with the normative guidance, tools, data, capacity building, and leadership needed to develop and deliver solutions for the health and wellbeing of everyone. All authors are staff members of WHO. The authors alone are responsible for the views expressed in this article and they do not necessarily represent the decisions, policy, or views of WHO. City planning policies to support health and sustainability: an international comparison of policy indicators for 25 citiesCity planning policies influence urban lifestyles, health, and sustainability. We assessed policy frameworks for city planning for 25 cities across 19 lower-middle-income countries, upper-middle-income countries, and high-income countries to identify whether these policies supported the creation of healthy and sustainable cities. We systematically collected policy data for evidence-informed indicators related to integrated city planning, air pollution, destination accessibility, distribution of employment, demand management, design, density, distance to public transport, and transport infrastructure investment. Full-Text PDF Open AccessUsing open data and open-source software to develop spatial indicators of urban design and transport features for achieving healthy and sustainable citiesBenchmarking and monitoring of urban design and transport features is crucial to achieving local and international health and sustainability goals. However, most urban indicator frameworks use coarse spatial scales that either only allow between-city comparisons, or require expensive, technical, local spatial analyses for within-city comparisons. This study developed a reusable, open-source urban indicator computational framework using open data to enable consistent local and global comparative analyses. Full-Text PDF Open AccessWhat next? Expanding our view of city planning and global health, and implementing and monitoring evidence-informed policyThis Series on urban design, transport, and health aimed to facilitate development of a global system of health-related policy and spatial indicators to assess achievements and deficiencies in urban and transport policies and features. This final paper in the Series summarises key findings, considers what to do next, and outlines urgent key actions. Our study of 25 cities in 19 countries found that, despite many well intentioned policies, few cities had measurable standards and policy targets to achieve healthy and sustainable cities. Full-Text PDF Open AccessDetermining thresholds for spatial urban design and transport features that support walking to create healthy and sustainable cities: findings from the IPEN Adult studyAn essential characteristic of a healthy and sustainable city is a physically active population. Effective policies for healthy and sustainable cities require evidence-informed quantitative targets. We aimed to identify the minimum thresholds for urban design and transport features associated with two physical activity criteria: at least 80% probability of engaging in any walking for transport and WHO's target of at least 15% relative reduction in insufficient physical activity through walking. The International Physical Activity and the Environment Network Adult (known as IPEN) study (N=11 615; 14 cities across ten countries) provided data on local urban design and transport features linked to walking. Full-Text PDF Open Access